This CME article makes plain, in our opinion, the problem of continuing medical education that is guided by obvious interests. On reading the article backwards from the end, starting with the authors’ conflicts of interest, one cannot help but notice that all six authors reported numerous financial links to the pharmaceutical industry.

Consequently, we were in a critical mood when we noticed some interesting aspects on reading the article:

According to one of the claims in Box 2, 45% of anxiety disorders are not recognized as such in primary care. The source material cited for this is a study conducted by the WHO that dates back 20 years, from which the authors conclude underprovision of care at present and thus suggest to the reader a substantial additional requirement for diagnostic evaluations and therefore therapies.

Among the therapeutic options, the authors repeatedly named escitalopram (Cipralex) as the drug of first choice—although, according to current state of knowledge, this drug does not offer any advantage with regard to patient relevant end points, but costs more than three times the price of a generic citalopram medication.

The ranking of pregabalin as the medication of first choice in general anxiety disorders was surprising to us. The obviously desired learning objective regarding pregabalin is strengthened by the subtle emphasis on the preparation in the subsequent questions. The repeated warnings from the Drug Commission of the German Medical Association (Arznei­mittel­kommission der Deutschen Ärzteschaft) about the potential for misuse of and dependency on pregabalin are not mentioned. All six authors reported links to Pfizer, the manufacturer of Lyrica (pregabalin).

Our conclusion: Mere transparency about competing interests alone is not sufficient. As a next step we need stricter rules for the medical associations for awarding CME certifications, and we would ask Deutsches Ärzteblatt as the journal of the German Medical Association to ensure that its CME offers are not tied to financial interests.

DOI: 10.3238/arztebl.2013.0609a

Dr. med. Niklas Schurig, Bietigheim, schurig@mezis.de

Manja Dannenberg, Wismar

Conflict of interest statement

Both authors sit on the board of the MEZIS e.V. [“I pay for my own meals”] initiative.